Basilar Perforator Aneurysms: Presentation of 4 Cases and Review of the Literature
Basilar Perforator Aneurysms: Presentation of 4 Cases and Review of the Literature
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DOI：
10.1016/j.wneu.2016.10.038
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发表时间：
2017-01-01
影响因子：
2
通讯作者：
Bracard, Serge
中科院分区：
文献类型：
--
作者：
Finitsis, Stephanos;Derelle, Anne-Laure;Bracard, Serge
目的：基底动脉穿支动脉瘤（BPA）是一种罕见的病变，提出了治疗的挑战。我们提出了4例破裂的BPA治疗保守或分流部署和审查literature.METHODS：患者（年龄78，59，53和62岁）提出了世界神经学会联合会等级I-IV和Fisher等级3-4蛛网膜下腔出血。3例患者的初始血管造影结果正常，需要进行第二次血管造影。BPA直径0.5 ~ 3 mm，位于基底动脉中1/3处2例，上1/3处2例。1例患者在初次发作后10天发生再出血，需要在基底动脉中部署血流导向装置。1例患者发生严重自发性脑桥缺血性卒中伴严重四肢轻瘫，拒绝进一步成像。在1年临床随访时，患者临床稳定。其他3例患者显示完全解决的BPA控制后续imaging.CONCLUSIONS：破裂的BPA是罕见的病变，可能自发愈合或与自发性缺血性脑干中风或再破裂。这些病变最初可采用血流导向装置进行保守治疗，在选定病例中，血流导向装置是最合适的治疗选择。需要更大规模的研究来充分了解这些病变的自然病程并完善治疗策略。
OBJECTIVE: Basilar perforator aneurysms (BPAs) are rare lesions that present a therapeutic challenge. We present 4 cases of ruptured BPAs treated either conservatively or by flow diverter deployment and review the literature.METHODS: Patients (age 78, 59, 53, and 62 years) presented with World Federation of Neurological Societies grade I-IV and Fisher grade 3-4 subarachnoid hemorrhage. Initial angiography results were normal in 3 patients and necessitated a second angiography. BPA diameter was 0.5-3 mm; BPAs were located in the mid-third of the basilar artery in 2 patients and the upper third in 2 patients.RESULTS: All patients were managed conservatively. One patient experienced rebleeding 10 days after initial ictus, which required the deployment of a flow diverter in the basilar artery. One patient developed a severe spontaneous pontine ischemic stroke with severe quadriparesis and refused further imaging. He was clinically stable at 1-year clinical follow-up. The other 3 patients showed complete resolution of BPAs on control follow-up imaging.CONCLUSIONS: Ruptured BPAs are rare lesions that may heal spontaneously or be associated with spontaneous ischemic brainstem stroke or rerupture. These lesions can be managed conservatively initially with flow diverter deployment the most suitable therapeutic alternative in selected cases. Larger studies are needed to fully understand the natural history and refine the therapeutic strategy for these lesions.